title: [Rare cause of recurrent hypoglycaemia in type 1 diabetes mellitus--case 6/2013].
abstract: METHODS
  We report on a 44-year-old patient with type 1 diabetes who suffered from vomiting and diarrhoea for 10 days as well as episodes of recurrent hypoglycaemia with reduced insulin requirements. Medical history was remarkable for nasopharyngeal carcinoma that had been treated by radiation and chemotherapy five years earlier.
  
  
  METHODS
  Laboratory results showed hyponatraemia, reduced free thyroxine with normal thyroid- stimulating hormone and diminished morning serum cortisol levels. Short synacthen test revealed inadequate stimulation of cortisol. Corticotropin-releasing hormone test showed a subnormal stimulation of cortisol with a strong increase of adrenocorticotropin. Besides, testosterone, luteinizing hormone and insulin- like growth factor-1 levels were reduced. The growth hormone-releasing hormone-arginine test revealed complete growth hormone deficiency. A MRI of the sella revealed no abnormalities in hypothalamus and pituitary gland.
  
  
  METHODS
  Findings were consistent with panhypopituitarism following radiotherapy for nasopharyngeal carcinoma. A replacement therapy was started comprising hydrocortisone, L-thyroxine and testosterone. Accordingly, symptomatology improved.
  
  
  CONCLUSIONS
  Obscure recurrent hypoglycaemia requires endocrinological tests to clarify possible underlying hypocortisolism.
authors.affiliation: Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schwarz
authors.forename: M
authors.initials: M
authors.lastname: Roden
authors.forename: A
authors.initials: A
authors.lastname: Fritsche
authors.forename: K
authors.initials: K
authors.lastname: Müssig
mesh_terms: D000328:Adult; D059248:Chemoradiotherapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007018:Hypopituitarism / Q000175:diagnosis*; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis*; D012008:Recurrence; D014839:Vomiting / Q000209:etiology